China Needs to Talk About Sex

China’s decision to allow all families to have two children rather than one has rightly been celebrated as a welcome expansion of reproductive rights. But the shift raises another question: What should the government do with the hundreds of thousands of bureaucrats who work for China’s National Health and Family Planning Commission and its local offshoots, now that they’ll have fewer fines to collect and births to prevent?

If hard times befall these often brutal enforcers, no tears should be shed. But there might be a very good use for them: providing family planning services to China’s rapidly changing society.

The need is dire. Over 70 percent of Chinese say they’ve had premarital sex. Yet almost none receive proper sex education or access to family planning services and counseling. HIV infections among students aged 15 and above are growing rapidly, and abortion has become the contraceptive of first resort for many Chinese couples.

Despite the fact that sex ed is required in Chinese schools, in practice it’s rarely taught. The reasons include a lack of qualified instructors and curriculum (that’s left up to local schools, who usually choose to do nothing), parental pressure to teach subjects that will be more useful in getting students into university, and above all, the social conservatism that pervades official China. Traditional Confucian values, which Chinese leaders have embraced, preclude premarital sex for women at least, as well as public discussions of it.

The consequences of this official silence are plain to see. In 2010, Peking University, in cooperation with the United Nations Population Fund, conducted China’s only national survey of youth access to and use of reproductive health services and education. Of 10,966 women between the ages of 15 and 25, only 4 percent displayed adequate knowledge of sexual and reproductive health, with those aged 15–19 the least knowledgeable. Sure enough, over half of those surveyed hadn’t used contraception in their first sexual encounter. (Rates were even higher among migrant workers.)

This week the Lancet published even more disturbing results from a large-scale national survey on the incidence of abortions among Chinese women. Of the 79,174 women surveyed in nearly 300 hospitals, 35 percent said they were having their first abortion, 37 percent their second, and 29 percent “a third or subsequent abortion.” Half of the women blamed contraception failure for their pregnancies; 44 percent said they hadn’t used contraception at all. Could education or other government-sponsored interventions have prevented some of these pregnancies? It’s difficult to say, not least because single and LGBT Chinese aren’t even eligible for government family planning services in China right now.

Fortunately, the Chinese government has many of the tools necessary to begin addressing these problems. Beyond mandating sex ed, officials need to start drafting, funding and imposing a national curriculum as soon as possible. Over the last two years, President Xi Jinping’s administration has pressured colleges and universities across China to purify their textbooks of Western influence; the same determination can and should be brought to bear on sexual health.

Next, the Family Planning Commission needs to establish a program offering counseling services to couples after abortions, with a focus on increasing the use of contraceptives and reducing future unwanted pregnancies. Pilot programs in China over the last decade have shown clear successes and should be expanded.

Finally, it’s essential that the commission and other government agencies recognize that unmarried Chinese, including the LGBT community and migrant laborers, need their help as much as married couples. This will require a difficult change in mindset for a socially conservative government. But China’s family planning issues are hardly exclusive to traditional couples, and universally available services would have broad, positive public health consequences. Long derided for interfering in its citizens’ reproductive lives, the regime at least has the resources and personnel available to provide such services. It’s time to try.

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